| NPI | 1447712088 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 1223P0221X Dentist Pediatric Dentistry (Licence: CA 104858) |
| Additional Taxonomies | 1223P0221X Dentist Pediatric Dentistry (Licence: NY 061963) |
| Enumeration Date | 2019-04-03 |
| Last Update Date | 2023-09-12 |